Facility Evaluation Report

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Mary Joyce Nora and explained the reason for the inspection. There are currently three residents at the facility of which all were seen watching tv and napping.

The facility is a one story home with three resident bedrooms, one resident bathroom, one staff bedroom, one staff bathroom, kitchen, living room, dining room, laundry room, attached two car garage and backyard. Facility appears clean, safe and sanitary. LPA observed the kitchen to be free of debris and vermin. LPA observed the toxins to be stored under the locked kitchen sink and made inaccessible to residents in care. LPA observed the sharps to be in a locked kitchen cabinet located next to the fridge and made inaccessible to residents in care. LPA observed the stove burners to be in working condition and have locks on them making it inaccessible to residents. LPA observed a fire extinguisher located by the kitchen to be charged with a service date of October 2, 2024. LPA observed the laundry room toxins to be locked in a cabinet located above the washer. LPA observed the emergency food and water supply to be located in the locked garage. LPA observed that all resident bedrooms had the required components and furnishings. LPA observed the resident bathroom to have toilet paper, paper towels and non slip floor mats. LPA observed the water temperature to be measured at 110 degrees Fahrenheit located in the residents bathroom in the hallway. LPA observed extra clean linens for residents use stored in the hall cabinet. LPA observed the staff bedroom to be locked and made inaccessible to residents in care. LPA observed all doors to have alarmed exits. LPA observed the backyard to be free of obstructions. LPA observed the backyard to have a shaded seating area for resident use. LPA observed the activities calendar along with extra activities in the facility such as books, puzzles and musical items. Continue on 809-C